title: Serial screening for melanoma: measures and strategies that have consistently achieved early detection and cure.
abstract: OBJECTIVE
  To determine the effectiveness of a serial screening program in achieving early detection and preventing death in patients at increased risk for melanoma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Private dermatology practice.
  
  
  METHODS
  The study included all patients at increased risk for melanoma who were screened in the program during the 17-year period, July 1, 1992-June 30, 2009 (=1108 patients per year).
  
  
  METHODS
  Survival and indicators of early detection.
  
  
  RESULTS
  All melanomas that developed in program participants during the 17-year period were detected early and there were no deaths, metastases, recurrences, nor need for sentinel node biopsies. An analysis of melanoma cases seen in five recent years revealed additional evidence of consistent early detection: 80 percent of the lesions were in situ, no lesions were greater than 0.15 mm in Breslow depth, and all lesions were in the radial growth phase, a stage almost always associated with cure. Four measures, often absent in mass screening programs, contributed to very early detection and cure: thorough serial examinations, biopsying suspicious lesions (particularly pigmented lesions that were highly irregular and/or approaching black in color), recalling patients every six months to detect all melanomas in the radial growth phase, and educating patients on the need to return.
  
  
  CONCLUSIONS
  An office-based surveillance program that includes serial full skin examinations and ongoing recalls appears capable of detecting melanoma at a very early stage when cures can be realized in almost every case. Therefore, when patients present with recognized risk factors for melanoma, dermatologists should seriously consider recommending and performing such serial screening procedures.
authors.affiliation: Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA. rnshorederm@gmail.com
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Shore
authors.forename: Paula
authors.initials: P
authors.lastname: Shore
authors.forename: Noel M
authors.initials: NM
authors.lastname: Monahan
authors.forename: James
authors.initials: J
authors.lastname: Sundeen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*